News & Publications
Revolutionizing Healthcare Payment Integrity with AI
Posted by tmorley
KISACO RESEARCH Revolutionizing Healthcare Payment Integrity with AI Download Report In the ever-evolving landscape of healthcare payment integrity, a new approach is emerging that promises to revolutionize how we detect and prevent fraud, waste, and abuse (FWA). Our latest report, “Advanced AI in Healthcare Payment Integrity: A Provider Centric Approach,” explores how combining a provider-centric perspective with cutting-edge AI technology can transform FWA detection and prevention. Traditional claims data-centric methods have long been the standard, but they often fall short in identifying dynamic, real-time changes in provider behaviors and relationships. Our research reveals a striking statistic: 75% of payers say … Read More
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NAMPI 2024: Provider-Centric FWA Prevention
Posted by tmorley
NAMPI 2024 Breakout session Provider-Centric FWA Prevention: The Value of Seeing Every Behavior, Pattern, Outlier & Relationship in Near Real-Time Watch on youtube Medicaid Program Integrity depends on having a continuous in-depth understanding of provider behaviors, patterns, outliers, and relationships in near real-time. Legacy provider credentialing and claims datacentric payment solutions are built on passive, rules-based platforms that can’t “see” dynamic changes in behaviors and relationships. This session will focus on a provider-centric FWA prevention approach. The 4L FWA Prevention solution is the provider-centric approach that utilizes patented Integr8 AI Risk Detection™ technology to detect dynamic changes in provider behaviors, … Read More
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4L Data Intelligence Featured in The Self-Insurer Magazine
Posted by tmorley
The Self-Insurer Magazine Combating Sophisticated Healthcare Fraud Schemes: Lessons for Self-Insured Health Plans Read Article 4L Data Intelligence, a leader in healthcare fraud prevention technology, is proud to announce that our Senior Fraud Advisor, Greg Lyon, has authored a featured article in the July 2024 issue of The Self-Insurer Magazine. The article, titled “Combating Sophisticated Healthcare Fraud Schemes: Lessons for Self-Insured Health Plans,” spans pages 36-45 and provides critical insights into the evolving landscape of healthcare fraud, offering valuable strategies for self-insured plans to protect their members and health plans from fraud. The article, appearing in the official publication of … Read More
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Educational Webinar in NHCAA’s Virtual Training Program
Posted by tmorley
LIVE WEBINAR 4L Data Intelligence Delivers Educational Webinar on Early Detection of Provider Collusion Schemes in NHCAA’s Virtual Training Program Watch NOW We’re pleased to announce that 4L Data Intelligence recently participated as a partner speaker in a webinar hosted by the National Health Care Anti-Fraud Association (NHCAA) as part of their “Schemes for Health Care Fraud Investigators & Analysts: A Virtual Training Program.” The live webinar, titled “Early Detection of Provider Collusion Schemes,” was held on Friday, May 24th, and included an informative Q&A session. Participants and attendees found the session highly educational, and students earned valuable credits for … Read More
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Stopping the Tsunami of Telehealth Fraud, Waste and Abuse
Posted by tmorley
By Theja Birur Surfers talk a lot about sets, groups of waves that keep coming one behind the other. While that may be a surfer’s dream, the continuous cadence of telehealth fraud, waste and abuse stories is looking more like sets of tsunamis coming one after the other. The dollar amounts of charges brought by the U.S. Department of Justice for telehealth and telemedicine fraud are staggering. Indictments for $4.5 billion and $1.2 billion are just the tip of the iceberg in a telemedicine market that is growing by 26.5 percent per year and expected to reach $475 billion by … Read More
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Study Showed 10% Of Workers Comp Claims Paid Were Fraudulent
Posted by tmorley
A 2021 4L Data Intelligence analysis of over four (4) million workers compensation claims paid showed that 19,612 providers out of a network of 86,000 submitted fraudulent claims totaling about 10% of all claims paid during the prior year. This study was conducted retrospectively using 2020 claims and network provider data for a regional workers compensation payer that paid about $107 million in fraudulent, wasteful or abusive claims on approximately $1.17 billion in total payments. 4L Data Intelligence deployed our Provider Intelligence & Integrity and FWA Prevention & Recovery solutions to retrospectively evaluate the integrity of previously paid claims, provide automated support data for … Read More
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Stopping The Catheter Fraud Scheme
Posted by tmorley
case study – GREG LYON Unmasking a $2 Billion Catheter Fraud Scheme: Lessons for Healthcare Payers Greg is a recognized anti-fraud expert with experience in Financial Services and Healthcare Payments that includes serving as Director of Fraud Prevention at United Healthcare. His guiding principle is, “The best way to fight fraud is to prevent it.” Greg is a graduate of Colgate University. Download Full Case Study
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Adopting AI Combats FWA And Overpayments
Posted by tmorley
Lately, it seems like everyone is either excited or worried about artificial intelligence (AI). Programs like ChatGPT are seemingly able to replicate human writing and speech patterns and can create new bodies of text based on simple (or not-so-simple) prompts. Similar technology is being used to create art, photographs, video, and music. For many, this is an exciting sign of things to come and promises a future where humans won’t have to waste time on menial tasks. Others, however, are worried that these complex algorithms will erase jobs and create further havoc in the jobs market. AI hasn’t skipped over … Read More
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4L Data to Host Panel on Improving Payer and Provider Value Using AI
Posted by tmorley
SAN RAMON, Calif. – Oct. 23, 2023 – 4L Data Intelligence™, the leader in patented AI-powered contextual claims analysis for fraud, waste, and abuse (FWA) prevention in healthcare, today announced it’s hosting a panel discussion titled “Improving Payer and Provider Value Leveraging AI.” This event will take place as a part of Octane’s Medical Innovation Forum 2023 on Oct. 25, 2023, from 1:30-2 p.m. at the Irvine Marriott. The panel will explore the transformative potential of artificial intelligence (AI) in the healthcare sector ‐ particularly how it can enhance payment integrity and streamline the complex payer-provider ecosystem. This thought-provoking session will delve into … Read More
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AI-Powered Fraud Prevention: 4L Data Intelligence and NHCAA Present Real-Time Claims Analysis Webinar
Posted by tmorley
4L Data Intelligence Announces Webinar with NHCAA on The Preventive Power of Contextual Claims Analysis: Real-time AI powered provider behavior analysis for pre-payment FWA excessive and overpayment prevention SAN RAMON, CA – June 21, 2023 – 4L Data Intelligence™, a leading provider of AI-powered solutions for the healthcare industry and Platinum Member of National Health Care Anti-Fraud Association (NHCAA), will host a webinar focused on the Preventive Power of Contextual Claims Analysis on June 27 at 1pm ET. For this webinar you will learn: The expanded pre-payment detection capability of provider-centric claims analysis The benefits of an ‘a-claim-and-all-claims’ approach to … Read More
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4L Data Intelligence and Hospice Dynamix Partner to Automate and Optimize Hospice Operations
Posted by tmorley
Leveraging AI to provide hospice organizations with continuous, automated predictive analyses of their financial and operational health SAN RAMON, CALIFORNIA – August 1, 2023 – 4L Data Intelligence™ , a leading provider of patented AI-powered solutions for the healthcare industry, today announced a partnership with Hospice Dynamix, a predictive analytics software platform from Diversified Health Technologies (DHT). This collaboration supports hospice agencies with patent-pending AI technology to forecast Medicare revenue, automate the Medicare cap projection for every open cap year, identify future compliance risks, and maximize census opportunities by enabling continuous and highly accurate predictive lengths of stay. “4L Data … Read More
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4L Data Intelligence Helps Find More Fraud Faster at NHCAA
Posted by tmorley
SAN RAMON, Calif. ‐ Nov. 6, 2023 ‐ 4L Data Intelligence™, the leader in patented AI-powered contextual claims analysis for fraud, waste, and abuse (FWA) prevention in healthcare, is hosting a panel titled “The Preventive Power Of Contextual Claims Analysis ‐ Find MORE Fraud FASTER.” This event will take place as a part of the National Health Care Anti-Fraud Association’s Annual Training Conference on Nov. 7, 2023, from 3:30-4:30 p.m. CT at the Hyatt Regency Dallas. The panel will explore the future of fraud detection ‐ particularly the need to evolve beyond traditional, claim‐centric methods. This thought-provoking session will delve into … Read More
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FWA Is Increasing. Healthcare Costs Are Spiraling.
Posted by tmorley
Theja Birur, Chief Technology Officer & Founder, 4L Data Intelligence In 2020, the Department of Justice estimated that fraudulent, wasteful, and abusive (FWA) billing practices account for more than $100 billion of the nation’s healthcare expenditures.1 Today, the National Healthcare Anti-Fraud Association (NHCAA) conservatively estimates that healthcare FWA costs the nation about $68 billion annually, representing 3% of the nation’s $2.26 trillion in healthcare spending.2 FWA estimates from commercial health plans range as high as $230 billion annually or 10% of total healthcare spending.3 Continue Reading Original Article ->
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Fighting Fraud, Waste, and Abuse in Digital Healthcare
Posted by tmorley
Clay Wilemon, chief executive officer at 4L Data Intelligence, spoke with Medical Device & Technology about the platform technology to help integrate AI in healthcare. The program is focused on improving integrity, specifically data, provider, and payment integrity. (MDT:) What are the struggles with insuring digital healthcare services? Wilemon: The digital healthcare services and solutions is a big landscape. One of the manifestations of the post COVID era is the increase in the delivery of digital health. We think about telehealth in terms of seeing your primary care physician, along with behavioral health and other solutions being delivered digitally. That has opened … Read More
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How Adopting AI Combats Fraud, Waste and Abuse Caused by Overpayment
Posted by tmorley
Briana Contreras, an editor with Managed Healthcare Executive, had a chat with Clay Wilemon, CEO of 4L Data Intelligence, in this month’s episode of Tuning In to the C-Suite. The discussion was on the subject of fraud, waste, and abuse within the healthcare industry and how much of it stems from issues like overpayment. Clay addressed how the adoption of artificial intelligence can help combat fraud, waste and abuse and shared how much the industry can save by using AI. Check Out The Full Interview –>
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